Central Australian Bushwalkers

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Membership and Risk Acknowledgement Form

Renewal 2nd March annually.

Pay $35.00 Central Australian Bushwalkers Association Bank BSB 633 000 – Account 164 265 886

Email *

First Name *

Family Name *

Mobile Number *

Address *

Emergency Contact - Name *

Emergency Contact - Relationship *

Emergency Contact - phone number *

The Central Australian Bushwalkers Association was formed to encourage and promote bushwalking in the rangelands of Central Australia and elsewhere. The association conducts a program of regular bushwalks, both on-track and off. Membership and acknowledgement of risk are requirements for our insurance through Bushwalking SA.

Annual membership costs $35 per person and is valid for one year to 2nd March.

Please Reference your payment with your name.

Central Australian Bushwalkers Association

Bank BSB 633 000

Account 164 265 886

I have made a bank transfer

Required

Central Australian Bushwalkers Association Acknowledgement of Risk

I am aware that my participation in the activities organised by the Central Australian Bushwalkers Association Inc. may expose me to hazards and risks that could lead to injury, illness or death, or to loss of or damage to my property.

Those risks may include, but are not limited to: uneven surfaces, steep cliff edges, rockfalls, falling tree limbs, submerged logs or rocks, steep ascents and descents, slippery slopes, hypothermia, heat exhaustion, sunburn and snake bite.

To minimise these risks I will:

1. provide complete and frank information on my capabilities and recent bushwalking experience to the walk leader before confirming participation.

2. undertake activities within my capabilities.

3. carry food, water and equipment suitable for the activity and wear appropriate clothing and footwear as described by the walk leader.

4. advise the walk leader if I am taking any medication or have any physical or other limitation that might affect my participation in the activity.

5. make every effort to remain with the party during the activity.

6. advise the walk leader of any concerns during the walk.

7. comply with all reasonable instructions of the walk leader and club officers.

Required

Acknowledgement of risk for all activities is a requirement for Central Australian Bushwalkers Association insurance which is held through Bushwalking SA.

I have read and understand these requirements.

I have considered the risks before choosing to sign this ‘Acknowledgement of Risk’ form.

I still wish to join the Central Australian Bushwalkers Association Inc.

I accept that in submitting this form I will take responsibility for my own actions.

Required

Send me a copy of my responses.

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